Challenges to saudi medical education in the third millennium.

Medical education began in Saudi Arabia in 1969 when King Saud University, the first medical school was established. Since then globalization has brought numerous challenges. In this paper, we review the status of medical education and its expected future projects.

The aim of medical education is to produce physicians with appropriate competencies to cater to the health needs of the community. The requirements of medical education therefore, vary according to the needs of the community where the physicians practice.1 The approach and quality of that education have to be evaluated in terms of culture, the expectations and the needs of the different communities.2–5

Though medical schools, together with their affiliated teaching and training hospitals and health centers constitute the core of medical education,6 in order to maximize the use of health resources other health institutions and private hospitals may also be used for teaching and training.7 The conduct of research, provision of health care besides training of graduate competent physician form part of the remit of medical schools. Consequently, the highest standard of medical education is expected of any medical institution.89

The objective of medical education is to train young physicians to acquire the necessary knowledge and skills to respond to the health needs of their community. They should strive to achieve this health objectives with care and compassion.10 Unfortunately, in a continually changing health care environment, there is concern that medical students are inadequately prepared to provide the best health care to the community they will serve.11

The global challenge to medical education emanates from the World Health Organization's goal of “Health for all by year 2000” in the 1978 Declaration of Alma-Ata.12 By the beginning of the third millennium, medical education should have produced clinically competent physician with the ability to provide health care to individuals and to the community.1 The adoption of this approach to health care and medical education triggered a worldwide educational and political movement, supported by many governments and regional medical education bodies, toward an educational reform for all health professionals.13

The first medical school in Saudi Arabia was established in 1969 by the Ministry of Education and named King Saud University. Thereafter, various medical schools have been established in different regions of KSA.14 However, what is lacking is a standardized structure by which these medical colleges may base and determine the format of education and the skills the doctors they train require to be able to cope with the demands of their professional careers.15–17

Unfortunate also is the fact that a majority of these medical colleges have no clear vision. Consequently, the objectives of the colleges are either obscure or unknown to most of the staff and the students.1819 Moreover, the curricula of these colleges are mere replications of medical curricula in the west, with little or no adaptation that recognize health needs of the community.20 Besides there is no uniformity of curricula and standards of the medical education across these colleges.21 In order to find out the reason for the absence of uniformity of standards in our medical colleges, the challenges in medical education in different parts of the world have been identified.22

Firstly, in many countries, there seems to be a gap between what people want and what the contemporary medical education system has to offer.23 The need for primary health care was recognized at Alma Alta in 1978. Primary health care suddenly invaded a well established system of medical education. The sense of proportion was lost and departments of primary health care, which suddenly became part of every medical college, rather than try to work in concert with other departments of medical colleges that took on a dictatorial position, demanding that primary health care should be taught to all levels of medical students for a maximum period of time.24

Secondly, medical colleges whose ambitions were to produce the best and safest doctors, were confronted with the need to produce the greatest number of doctors as quickly as possible, to serve the rising populations of the world, in order to meet the WHO target of “health for all by year 2000”. The result was the loss of quality for the sake of quantity, especially in developing countries where health care was the least developed.24

There was a lack of proportion and balance between PHC and clinical medical care education. Material that was irrelevant to the community continued to be taught, standards were compromised, and some colleges even reduced the training period necessary to produce safe doctors.22

Another problem in medical education in Saudi Arabia relates to the first year after qualification or the internship year. The first year as a doctor, or internship, is the most stressful time of the physicians professional life, or the weakest link in the entire chain of physician training.25 Recommendations to reduce the stress of internship have focused on improving working conditions and providing support systems for junior doctors.26 The internship year is an important part of undergraduate education and training for the medical students, but the internship experience varies a great deal. Graduates need to be well prepared for clinical practice, so appropriately designed internship programs are necessary to provide a balance between their performance at work and their education and training so that the practical experience provides not simply confidence but also competence.27 Many medical undergraduate curricula provide inadequate preparation for internship, as evidenced by the high incidence of emotional distress of junior doctors and their reported dissatisfaction with undergraduate training.27

Another challenge in medical education in Saudi Arabia is the problem of recruitment and retention of expertise such as academics, educationalists and professionals in the institutions. These highly qualified professionals manage and direct medical education programs. The reason for the problems is the salaries, compensation, benefits that make no distinction between the different roles of these doctors such as teaching, research, professional and community service they provide.28 The role of academic medicine as the focus and the most suitable environment for training has not yet been recognized by the government, especially Ministry of Finance. Student selection is still based on an old process of selection in spite of new standardized test run by National Center for Assessment in Higher Education (Qiyas).

In summary,

There are many challenges to medical education in Saudi Arabia in the 21st century. These challenges can easily be addressed if decision makers use the expertise of medical education providers to look into the current status of medical education in order to identify, determine and properly plan for the future needs of the society.